Have you ever seen doctors ask, "What is the GCS score?" when someone is brought to the hospital after an accident? Or when someone loses consciousness, they say, "The GCS is low"? You may also be wondering what this GCS is and what it measures. This is really important. So today, let's talk about it very simply, in a way that you can understand.
What does GCS simply mean?
Simply put, the Glasgow Coma Scale (GCS) is a scoring system that measures and rates a person's level of consciousness. Much like grading an exam, it allows doctors to assess how awake a person is, how aware they are of their surroundings, and how well they respond to simple instructions.
This method was first developed in 1974 by a group of specialists at the University of Glasgow in Scotland. That's why it got its name. Although the word "coma" is in the name, today it has become the main method accepted in the world, used not only in comas, but also in any situation where consciousness may be impaired.
What is 'Consciousness' in medicine?
We say 'conscious' when three main things are met. When a doctor measures your consciousness, they focus on these three things.
| The point | Simple explanation |
|---|---|
| Staying awake (Awake) | This isn't like just waking up from sleep. You can wake up when someone speaks to you, or when you pat your body. You can't wake someone up in a coma like that. |
| Alert | The ability to understand things like what is happening around you and who is talking. |
| Place-time-person understanding (Oriented) | The awareness of where you are and time, such as who you are, where you are, what day it is, and what time it is. |
When is GCS used?
GCS is a very important part of a neurological exam performed by doctors. It is used especially in cases where a person may be losing consciousness.
- Head injuries: The GCS is used to assess everything from minor injuries like a concussion to severe traumatic brain injuries. The GCS score is one of the main things doctors look at when a person is brought to the ETU (Emergency Treatment Unit) after an accident.
- Other medical conditions: There are also cases where loss of consciousness can occur even without an accident. For example:
- Very low blood sugar (hypoglycemia)
- After a seizure
- Poisoning
Important: If someone ingests a poison or accidentally ingests it, medical advice should be sought immediately. You can call the National Poisons Information Centre at the Colombo National Hospital for quick advice.
What are the 3 main areas of GCS scoring?
A doctor assigns a GCS score based on the patient's responses in three main areas. The total GCS score is calculated by adding these three areas together.
1. Eye Response (E): This mainly measures how awake and alert the person is.
2. Verbal Response (V): This tests brain functions such as a person's thinking ability, memory, and awareness of the world around them.
3. Motor Response (M): This tests how well the brain can control muscles, follow instructions, and whether the nervous system is functioning properly.
Now let's see how to score each of these sections.
| Response | How to check and characteristic | Score |
|---|---|---|
| 1. Eye Response (E) | ||
| Spontaneously | Without doing anything, the patient naturally keeps their eyes open. | 4 |
| When spoken to | They open their eyes when their name is called or when they hear something. | 3 |
| For pain/pressure | When a fingernail is pressed lightly (pressure is applied), the eyes open. | 2 |
| No response. | There's no way to open your eyes. | 1 |
| 2. Verbal Response (V) | ||
| With understanding | When asked who they are, where they are, and what their day is like, they answer accurately. | 5 |
| Confusedly | They're talking, but they don't know exactly where they are or what happened. They're talking in confusion. | 4 |
| Inappropriate words | They talk, but they say meaningless words that are completely irrelevant to the question being asked. | 3 |
| Unintelligible sounds | They don't utter words, but only make meaningless sounds like groans. | 2 |
| No response. | Doesn't make any sound. | 1 |
| 3. Motor Response (M) | ||
| Following instructions | Simple instructions like "raise your hand" and "stick out your tongue" are followed exactly. | 6 |
| Focusing on the pain | When a part of the body is pressed, the person tries to touch or remove the painful area. | 5 |
| Getting rid of pain | Instead of trying to touch the painful area, they try to distance themselves from the pain. | 4 |
| Unnatural bending | In response to pain, the limbs bend unnaturally towards the chest. | 3 |
| Unnatural stretching | In response to pain, the limbs straighten and stretch unnaturally. | 2 |
| No response. | There is no body movement. | 1 |
What is the new method called GCS-P?
Recently, the GCS system has been further developed and a new feature called GCS-P has been added. Here, the letter 'P' stands for 'Pupil', which means the pupil of the eye . The pupil's response to light can tell a lot about brain function. Therefore, this is also looked at along with the GCS score.
- Score 0: The black rings in both eyes respond to light.
- Score 1: Only one eye responds.
- Score 2: No response in both eyes.
This score is subtracted from the previous GCS score. That is, if the GCS score is 3 and there is no response in both eyes (score 2), the GCS-P score is 1 (3 - 2 = 1). This means that the patient is in a very deep coma.
What do the signs say?
The sum of the GCS scores can provide a rough idea of the patient's condition.
- The maximum score is 15. (E4 + V5 + M6 = 15). This means that the patient is fully conscious, speaks well, and is aware of his surroundings.
- The lowest score is 3. (E1 + V1 + M1 = 3). This means that the patient is in a deep coma, unresponsive.
Generally, a GCS score of 8 or less is considered a coma. The lower the score, the more serious the condition is.
In head injuries, the severity of the injury is classified according to the GCS score.
- Score 13-15: Mild traumatic brain injury - like a concussion.
- Score 9-12: Moderate TBI.
- Score 3-8: Severe TBI.
What should I know about my child's GCS score?
If a family member or friend of yours is hospitalized and the doctors are talking about GCS scores, don't panic and keep these things in mind.
- This is not just a score. Although the GCS score gives a rough idea of the patient's condition, there is a lot of information behind it. Therefore, instead of just listening to the score, talk to your doctor to get a complete picture of the patient's condition.
- GCS cannot always be used. In some cases, GCS scores cannot be measured accurately. For example, if someone is connected to a ventilator to help them breathe, speech responses cannot be measured. Also, if the eyes have been injured, eye responses cannot be seen.
- GCS is not the only tool used to predict prognosis. Although doctors use GCS scores to predict a patient's prognosis, they do not look at it alone. They also consider other tests, such as CT scans, and the patient's overall health.
Take-Home Message
- The Glasgow Coma Scale (GCS) is an internationally accepted scoring system that measures a person's consciousness.
- This tests responses through eyes, speech, and body movements.
- The score ranges from 3 (deep coma) to 15 (full consciousness). A score of 8 or less is considered severe.
- By regularly checking the GCS score, doctors can understand whether the patient's condition is improving or worsening.
- If you find out about a loved one's GCS score, don't just worry about the number. Always talk to your doctor and understand the full situation clearly.
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